This is the second in a series of posts about problems during sex, such as pain or the inability to orgasm. (Check out part one: how to talk to health care providers about pain during sex.)
I’ve been interviewing researchers and therapists about the issue of problems during sex and have run into a question that I’d like to address:
What counts as a dysfunction?
The conversation around sexual health includes, among other things, a complicated mix of cultural norms and academic and clinical research. Clinical language often refers to issues as “sexual dysfunctions,” and what gets included is a sticky topic.
What might be a sexual dysfunction? The answer is broader than you might think and includes anything that disrupts a person’s sexual functions, including issues with arousal, orgasm, and sex drive: the inability to relax during sex, frequent disinterest in sex, difficulty getting aroused, reaching orgasm too quickly, too slowly, or not at all and, of course, physical pain and discomfort during sex.
Labeling something a dysfunction has an inherently negative connotation. And it can lead someone to think they’re not normal, which is probably not true. For instance, the majority of people with vulvas do not orgasm via vaginal penetration, and yet that’s still a common expectation many people hold. Should that be considered a dysfunction? Probably not.
There’s also a misconception that sex is easy and enjoyable for the average person. In reality, it’s more common than not to run into some problem or another during sex.
So does that mean all hope is lost to have an enjoyable and meaningful sex life?
In this series, we’re discussing ways to move beyond the shame and stigma of dysfunction, ways to bring up issues with health care providers and intimate partners, and creative ideas to prioritize what’s working right.
Ultimately the goal of this series is to empower individuals around their bodies and relationships. Sometimes empowerment means recognizing and being able to act on an issue like physical pain or trauma. At other times, however, empowerment looks like recognizing there’s no issue after all, and you just need a different perspective.
As always, take on whatever language and labels feel good for you. I hope you read this series with curiosity and self-kindness.
Without further ado, here’s part two:
How to talk to a partner about problems during sex, such as pain or discomfort, and how to support a partner experiencing them.
This is one of Dr. Natalie Rosen’s specialties. She is a research professor at the Department of Psychology and Neuroscience at Dalhousie University and a registered clinical psychologist with a private practice.
Much of the research and discussion around pain during sex and other sexual dysfunctions focuses on the person experiencing the problem, but Rosen understands it as an interpersonal issue that impacts both people in a relationship. Her research and private practice often focus on pain and other sexual issues from a couple’s perspective.
In one of her studies, Rosen and her fellow researchers found that people who are able to talk to their partners about sexual issues experienced fewer depressive symptoms, and greater sexual functioning and overall relationship satisfaction than those who did not discuss the issue with their partners.
Sounds good, right? But how do you talk about it?
Jera: Do you have general advice for people who are experiencing some form of sexual dysfunction?
Dr. Natalie Rosen: I think like the general starting point is to figure out a way that you can bring it up with your partner, your healthcare provider or even friends. People with sexual dysfunction really struggle in feeling isolated because it’s hard to talk about with other people. Unlike problems at work or even problems in your relationship, it’s harder to talk about sex with friends, especially if you and your partner are struggling to talk about it with each other. So that feeling of isolation can also be really linked to things like depressive symptoms. I think the campaigns that are out there right now to normalize sexual dysfunction and let people know that it is really common can help reduce some of that stigma and that feeling of isolation that people have around that.
How do you start the conversation with your intimate partners?
Timing is really important. Couples fall into the trap of bringing it up when emotions are already running high. Let’s say one person initiates sex and the other person declines or rejects them for it. Then, one of them is feeling guilty and the other one’s feeling resentful, and that’s when they start talking about, ‘We never have sex.’
Or they bring up sex when they might not have really enough time or energy to talk about it, just before bed or when the kids are getting home in half an hour. So one of the most important tips is actually thinking about a time that you have the space and energy to have the conversation and to give your partner a heads up so that they’re not caught off guard.
So you can say, ‘Saturday after the kids go to bed, I want to talk a little bit about our sex life. Can we put aside that time for it?’ You’re both going to be more emotionally ready to have that a potentially higher arousing conversation than in the moment when sex is on the table.
The other key thing that I talk about when I’m teaching and working with couples around communication around sex is to try and speak from the impact for you—speaking from the ‘I.’ A place of ‘I’m feeling’ or ‘this has impacted me’ rather than ‘when you do this, it’s bad because,’ which is going make the other person feel much more defensive.
The point is to try and think about how to approach it from perspective of the impact it has on you and how you’re feeling as an individual rather than blaming your partner, which can spark more defensiveness. So instead of saying, ‘You are always turning me down for sex,’ you can say, ‘I feel really hurt when I’m interested in having sex with you and you’re not interested.’
So that’s advice for how to a partner can approach the conversation with someone who’s potentially having some sort of dysfunction.
Or the other way around, because sometimes the person who’s having the dysfunction also needs to talk about how they’re feeling and how they’re managing it.
The literature around what a potential dysfunction is has really broadened my perspective of what might be included in these conversations. Like, sure, pain is an obvious problem. But what about difficulties getting aroused? How do we approach what we view as a “problem?”
I’d encourage you to think about or maybe read a little bit more about this idea of “responsive sexual desire and arousal.” So we used to think, and what the popular media portrays, is that people have this expectation that desire should be spontaneous. Like you should look at your partner and want to rip their clothes off, or your partner looks at you, and you’ve got to be turned on. Desire is just going to emerge out of nowhere when you get into bed and you’re interested and ready for sex. And that’s really not what it looks like for a lot of people, especially women. We know that a lot of women experience more of what’s called responsive desire. So they might in a neutral space, and their arousal gets stimulated through kissing and touching. When the sexual activities start, that’s what actually stimulates desire and arousal to keep going.
That conceptualization can be really meaningful to couples and women who feel like they’re somehow abnormal. That when they were horny teenagers, it felt like they could just turn it on and off. Now as adults, especially when they’ve been in a relationship for a while, it’s not so easy to just turn it on and off like that.
[Note from Jera. A lot of the research that’s been done on topics like responsive sexual desire or arousal prioritize heterosexual couples and do not look at or identify the gender spectrum. In my next post on problems during sex, we’ll specifically be looking at things from a queer perspective. But, however you identify, I hope you take what’s useful from this conversation.]
So we’re stuck in traditional (and unhelpful) scripts around arousal and desire. Relatedly, we’re stuck in scripts about what sex is supposed to look like or what is supposed to feel good. Quoting one of your studies:
Telling one’s partner about a sexual problem may relate to overall sexual functioning … by allowing the couple to adapt their sexual activities to accommodate the sexual problems, for example, less focus on vaginal penetration if there is pain during sex.
I see where you’re going. A really important target for intervention is getting couples to expand their conceptualization around what sex is and to consider that a variety of sexual activities can be pleasurable and satisfying. A lot of people come in with this myth that the only true form of sex is intercourse, but then when you actually start talking to them about the times when they take intercourse off the table and focus either on mutual masturbation or taking turns and pleasuring each other, how pleasurable and satisfying that sexual experience is. So why doesn’t that count?
A lot of it comes down to the scripts that are present in our society about what sex has to look like and how it progresses. Really trying to look at more flexible ideas of what sex is and what it can look like and how it can be satisfying is very important and can be really helpful for couples.
For more information:
Read Jera’s tips on how to create more flexible sexual scripts.
And check out our entire Guide to Reclaiming Pleasurable Sex for Folks with Pelvic Pain.